What is the relationship between nurses’ social networks and the use of evidence- based practices?: A mixed methods case study
Elise Arsenault Knudsen, Marlon Mundt, Linsey SteegeBackground: Implementation science has identified social networks, leadership, and communication as variables that influence the uptake of evidence-based practices (EBPs); however, little is known about these variables among hospital nurses. Nurses have a critical role in providing evidence-based care and improving patient outcomes, especially related to hospital acquired conditions (HACs). Hospitalized patients experience HACs while being treated for something unrelated; EBPs can prevent the occurrence of HACs. The Systems Engineering Initiative for Patient Safety (SEIPS) model links the work system’s structure to care processes and outcomes. This study, guided by the SEIPS model, examines the relationship between nurses’ communication and advice networks, the use of EBPs for HAC prevention, and HAC outcomes.
Purpose: To describe hospital nurses’ communication and advice networks and to explore their relationship with the use of evidence-based practices (EBPs) to prevent hospital-acquired conditions (HACs) and HAC outcomes.
Methods: In this mixed methods case study, two inpatient nursing units (Unit A and Unit B) at one hospital with variation in adherence to EBP processes were purposively sampled. All of each unit’s core nursing staff, unit leaders, and nursing executives were invited to participate. Sociometric surveys were administered face-to-face, using a roster of names, and collected data about the frequency of communication and advice-seeking patterns about practice changes specific to HACs. Interviews were conducted with unit leaders and executives to gain an understanding of the context of communication on each unit as it related to HAC-related practice changes. Social network analysis and descriptive statistics were used to analyze the quantitative data; directed content analysis was used for the qualitative data.
Results: The total sample included 149 nurses; 86 on Unit A (92% response rate), 61 on Unit B (98% response rate) and 2 nurse executives (100% response rate) participated. The network structures between the units varied little; those nurses in roles as unit leaders or charge nurses were central to the communication and advice networks. Both units revealed a high frequency of a lot of communication among their nurses about HAC-related practice changes (density: Unit A = 0.073 and Unit B= 0.113). The context for the task of communication aligned with the SEIPS model but was described differently on each unit; Unit A focused on the mechanisms for communication and Unit B described creating relationships among staff. Adherence to EBPs to prevent HACs was higher on Unit B than Unit A.
Conclusions: These data provide new knowledge about communication and advice network structure among hospital nurses regarding practice changes specific to HACs. These networks identified central (opinion leaders) and peripheral network members, which could be used to optimize focused communication strategies using prominent members to facilitate the uptake of EBPs. The converged qualitative and quantitative data suggest opportunities for exploring the impact of bidirectional communication and how message content about practice change influences implementation. This mixed methods case study highlights the complexity of implementation and offers new insight into how to facilitate the uptake of EBPs among hospital nurses and ultimately improve patient outcomes.